Updated 04 July 2014

Back manipulation may help relieve chronic pain

Osteopathic manipulation may modestly reduce symptoms for some people with chronic low back pain, a new study suggests.

Osteopathic manipulation may modestly reduce symptoms for
some people with chronic low back pain, a new study suggests. The treatment
involves moving out-of-line joints back into place, relaxing overused muscles
and massaging soft tissue, said Dr John Licciardone, a doctor of osteopathic
medicine who led the new study.

He considers osteopathic manipulation a complementary
treatment - not necessarily the only thing to do for low back pain, but something
that can work as an add-on therapy for people who don't get better with
painkillers alone, for example.

"I think the osteopathic approach is different (from
chiropractic care, for example) in that it takes a more overarching view, so
you wouldn't necessarily restrict your examination or treatment to the lower
back," Licciardone, from the University of North Texas Health Science
Center in Fort Worth, told Reuters Health.

How the study was
done

He and his colleagues wanted to test the effectiveness of
both osteopathic manipulation and ultrasound therapy - a technique sometimes
used by physical therapists on soft tissue injuries. The researchers randomly
assigned 455 people with chronic low back pain to undergo eight weeks of either
real or sham versions of each treatment method.

A few weeks after finishing treatment, 63% of the patients
who'd had osteopathic manipulation reported a moderate improvement in their
pain and half reported substantial improvement - meaning their symptoms were at
least cut in half.

In comparison, 46% of people who'd received fake osteopathic
treatments had moderate improvement and 35% saw substantial benefits. Ultrasound
therapy, on the other hand, was not tied to any long-term pain relief.

And neither treatment significantly improved back-related
functioning or the overall health of people with chronic pain, the study team
wrote in the Annals of Family Medicine. Licciardone said chiropractors
typically use a single type of thrusting motion on the back and see some
patients up to three times per week.

What osteopathic care
does

In contrast,
osteopathic care addresses the pelvis, legs and other body parts as well and
emphasizes allowing recovery between sessions. In the current study, patients
received a total of six treatments over eight weeks.

The study was funded by the National Institutes of
Health-National Center for Complementary and Alternative Medicine and the
Osteopathic Heritage Foundation. One back pain researcher who wasn't involved
in the new study said its findings are consistent with past reports on
osteopathic and chiropractic treatments.

"The consensus on most of those studies, I think, is
that spinal manipulative therapy is better than no treatment and has a modest
benefit over a period of time, but is not substantially better than other types
of treatment including pain medications (and) exercise recommendations,"
said Dr Timothy Carey, from the University of North Carolina, Chapel Hill. A
typical osteopathic manipulation session costs about $100, and may or may not
be covered by insurance.

People who tried over-the-counter
medication

That may be worth it, Licciardone said, for people who have
already tried over-the-counter painkillers and physical therapy and are running
out of non-invasive options."We saw the biggest reduction in pain in the
people who had more severe pain to begin with, and those are the people who are
going to be more likely looking for the more costly and more invasive
treatments," he said.

"Before going on to the opioid medications or steroid
injections or surgery, why not give a conservative treatment like osteopathic
manual treatment a try?" Licciardone suggested."I say (to patients),
'Give it a try for five or six treatments, and if it's not helping by then,
give it up, because it's not going to help,'" Carey told Reuters
Health."It's an option - it isn't the only option," he said. Carey
said one of the best things people with chronic back pain can do for their
long-term health is to get regular exercise, even if it's just walking.

Ask the Expert

Susan qualified as a Physiotherapist in 1990, and completed her master’s degree in Physiotherapy in 2013 at the University of Pretoria. She has a special interest in human biomechanics, as well as the interaction between domestic and work-related ergonomics.

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